醫(yī)療衛(wèi)生機(jī)構(gòu)論文：醫(yī)療衛(wèi)生機(jī)構(gòu)無煙環(huán)境創(chuàng)建效果評估及影響因素研究

醫(yī)療衛(wèi)生機(jī)構(gòu)論文：醫(yī)療衛(wèi)生機(jī)構(gòu)無煙環(huán)境創(chuàng)建效果評估及影響因素研究醫(yī)療衛(wèi)生機(jī)構(gòu)論文：醫(yī)療衛(wèi)生機(jī)構(gòu)無煙環(huán)境創(chuàng)建效果評估及影響因素研究【中文摘要】評價(jià)醫(yī)療衛(wèi)生機(jī)構(gòu)無煙環(huán)境創(chuàng)建效果；研究影響醫(yī)療衛(wèi)生機(jī)構(gòu)無煙環(huán)境創(chuàng)建效果的主要因素和創(chuàng)建中存在的主要問題；了解無煙醫(yī)療衛(wèi)生機(jī)構(gòu)評分表在實(shí)施中存在的主要問題。方法：采用定量研究數(shù)據(jù)分析和定性研究相結(jié)合的方法。定量研究數(shù)據(jù)來自于中央補(bǔ)助地方煙草監(jiān)測和干預(yù)項(xiàng)目。該項(xiàng)目通過非隨機(jī)分層抽樣的方法,在每省創(chuàng)建20家無煙醫(yī)療衛(wèi)生機(jī)構(gòu),并從2009年5月30日至11月30日開展為期半年的干預(yù)活動。在干預(yù)活動前后分別開展一次基線和終末問卷調(diào)查。利用604家醫(yī)療衛(wèi)生機(jī)構(gòu)干預(yù)前后的調(diào)查數(shù)據(jù)對無煙環(huán)境的創(chuàng)建效果進(jìn)行評價(jià)。干預(yù)活動評價(jià)指標(biāo)為無煙政策指標(biāo)、無煙支持環(huán)境指標(biāo)、控?zé)熜麄髋嘤?xùn)指標(biāo)。干預(yù)效果評價(jià)指標(biāo)為無煙環(huán)境執(zhí)行指標(biāo)、二手煙暴露指標(biāo)、工作人員控?zé)熤R、態(tài)度、行為指標(biāo)。利用SAS9.1統(tǒng)計(jì)軟件完成定量資料的數(shù)據(jù)清理和統(tǒng)計(jì)分析。統(tǒng)計(jì)分析方法主要包括描述性分析、卡方檢驗(yàn)、符號秩和檢驗(yàn)和Logistic回歸分析。定量數(shù)據(jù)完成后,采用個人深入訪談的方法,在北京訪談熟悉無煙醫(yī)療衛(wèi)生機(jī)構(gòu)創(chuàng)建工作的控?zé)熑藛T21名。利用ATLASTI5.0軟件完成訪談資料的整理和主題編碼,并對各訪談主題進(jìn)行歸納總結(jié)。結(jié)果：1.醫(yī)療衛(wèi)生機(jī)構(gòu)無煙環(huán)境創(chuàng)建效果評估1)制定禁煙規(guī)定的機(jī)構(gòu)比例由干預(yù)前的53.5%上升至干預(yù)后的92.1%,銷售煙草制品的機(jī)構(gòu)比例由干預(yù)前的16.5%降至干預(yù)后的6.3%；過去一年,工作人indoorworkplacewas80.8%,comparedto71.9%beforetheintervention.Thecurrentsmokingprevalenceamongthestaffdecreasedfrom17.6%to15.2%.But82.9%ofthecurrentsmokerssmokedduringworktimeintheirworkplaceafterintervention.2.InfluencefactorsassociatedwiththeeffectsofcreatingsmokefreehealthcarefacilitiesThetotalscoreforsmokefreeenvironmentwas30,themedianscoreforallhealthcarefacilitiesincreasedfrom12to25aftertheintervention.Fromtheresultsoflogisticregression,wefoundfactorsassociatedwithbettereffectsincluded1)tobaccocontrolintervention(relativetothatbeforeintervention)2)Facilitieswithtobaccocontrolrule(relativetofacilitieswithouttobaccocontrolrule)3)Facilitieswithhighersupportratefor100%smokefreeintheirindoorworkplace(relativetofacilitieswithlowersupportrate)4)Facilitieswithhigherproportionofstaffwhohadbeentrainingontobaccocontrol(relativetofacilitieswithlowerproportionofstaffwhohadbeentrainingontobaccocontrol).Factorsassociatedwithworseeffectsincluded1)facilitieswithhighersmokingprevalenceamongstaff(relativetofacilitieswithlowersmokingprevalenceamongstaff)2)facilitieswhichsoldcigarette(relativetofacilitieswithoutcigarettesale).Factorswithnostatisticalsignificanceinclude1)whetherornotthefacilityhadtobaccocontrolpropagandamaterials2)whetherornotthefacilityhadanti-smokingsigns3)whetherornotthefacilityhadsmokingareas.Fromin-depthindividualinterviewstudy,wealsofoundthatsettingtobaccocontrolsupervisionandinspectionteamwasthemostimportantfactorassociatedwiththeeffects.Andgettingleadershipattentionwasthekeypointforcreatingsmokefreeenvironment.Conclusion:1.Bigprogresshasbeenmadeincreatingsmokefreehealthcarefacilities,butthereisstillmuchworktodotofulfillthe“2011Decision”.2.Settingtobaccocontrolsupervisionandinspectionteamisthemostimportantfactorandgettingleadershipattentionisthekeypointforcreatingsmokefreeenvironment.3.Barriersforcreatingsmokefreehealthcarefacilitiesinclude1)inadequateenforcementofsmoke-freepolicy2)lackofcapacityofsupervisionteamtodiscouragesmoking3)theseriousproblemofmalephysiciansmokers(especiallythesurgeon)smokingduringworktime.4.Theevaluationcriteriaforsmokefreehealthcarefacilityneedtobeimprovedinvariablesandweights,andadetailedscoringmethodisstillneeded.【關(guān)鍵詞】醫(yī)療衛(wèi)生機(jī)構(gòu)無煙環(huán)境效果評估影響因素【英文關(guān)鍵詞】Healthcarefacilitiessmokefreeenvironmentevaluationinfluencefactors【目錄】醫(yī)療衛(wèi)生機(jī)構(gòu)無煙環(huán)境創(chuàng)建效果評估及影響因素研究

中文摘要

5-7

英文摘要

7-9

第一章前言

10-14

研究背景

10-13

研究意義

13

研究目的

13-14

第二章研究方法

14-23

一定量研究方法和內(nèi)容

15-21

二.定性研究方法和內(nèi)容

21-23

第三章結(jié)果與分析

23-40

一、定量研究結(jié)果

23-33

二、定性研究結(jié)果

33-40

第四章討論

40-44

一、評價(jià)指標(biāo)的選擇

40

二、廣義估計(jì)方